Provider Demographics
NPI:1093838419
Name:WINSLOW CONVALESCENT CENTER INC
Entity Type:Organization
Organization Name:WINSLOW CONVALESCENT CENTER INC
Other - Org Name:WINSLOW CAMPUS OF CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-289-4678
Mailing Address - Street 1:826 W DESMOND STREET
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047
Mailing Address - Country:US
Mailing Address - Phone:928-289-4678
Mailing Address - Fax:928-289-2893
Practice Address - Street 1:826 W DESMOND ST
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047
Practice Address - Country:US
Practice Address - Phone:928-289-4678
Practice Address - Fax:928-289-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI 2284314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ488181Medicaid
AZ035254Medicare Oscar/Certification